Search

The assessment of functional status is a critical component of clinical neuropsychological evaluations used for both diagnostic and therapeutic purposes in patients with cognitive brain disorders. There are, however, no widely adopted neuropsychological tests that are both ecologically valid and easily administered in daily clinical practice. This discrepancy is a roadblock to the widespread adoption of functional assessments. In this paper, we propose a novel approach using a serious game authoring platform (eAdventure) for creating screen-based simulated functional assessments. We created a naturalistic functional task that consisted of preparing a cup of tea (SBS-COT) and applied the assessment in a convenience sample of eight dyads of therapists/patients with mild executive dysfunction after traumatic brain injury. We had three main aims. First, we performed a comprehensive review of executive function assessment in activities of daily living. Second, we were interested in measuring the feasibility of this technology with respect to staffing, economic and technical requirements. Third, a serious game was administered to patients to study the feasibility of this technology in the clinical context (pre-screening test). In addition, quantitative (Technology Acceptance Model (TAM) questionnaires) and qualitative (semistructured interviews) evaluations were applied to obtain user input. Our results suggest that the staffing, economic and technical requirements of the SBS-COT are feasible. The outcomes of the pre-screening test provide evidence that this technology is useful in the functional assessment of patients with executive dysfunction. In relation to subjective data, the TAM questionnaire showed good user acceptability from a professional perspective. Interview analyses with professionals and patients showed positive experiences related to the use of the SBS-COT. Our work indicates that the use of these types of authoring platforms could have positive long-term implications for neuropsychological research, opening the door to more reproducible, cooperative and efficient research by allowing the facilitated production, reuse and sharing of neuropsychological assessment tools., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The inability to carry out activities of daily living (ADL) is prevalent in elderly people and it is associated with hypertension and stroke., Aim: To evaluate ADLs using the T-ADLQ in hypertensive patients with minor stroke., Subjects and Methods: T-ADLQ, Cognitive tests (Minimental and Addenbrooke), and Hamilton depression test were applied to 100 hypertensive ambulatory patients (55 without symptomatic stroke and 45 with ischemic stroke, Rankin ≤ 2)., Results: In stroke patients the ability to perform ADL was significantly reduced compared with hypertensive patients without stroke. Cognitive dysfunction and depressive symptoms were associated with a lower ADL performance., Conclusions: The T-ADLQ is useful to evaluate ADL in hypertensive ambulatory patients with ischemic stroke.

Background: Intracellular neurofibrillary tangles are part of the core pathology of Alzheimer's disease (AD), which are mainly composed of hyperphosphorylated tau protein., Objectives: The purpose of this study is to determine whether high molecular weight (HMW) or low molecular weight (LMW) tau protein levels, as well as the ratio HMW/LMW, present in platelets correlates with brain magnetic resonance imaging (MRI) structural changes in normal and cognitively impaired subjects., Methods: We examined 53 AD patients and 37 cognitively normal subjects recruited from two Memory Clinics at the Universidad de Chile. Tau levels in platelets were determined by immunoreactivity and the MRI scans were analyzed using voxel-based morphometry in 41 AD patients., Results: The HMW/LMW tau ratio was statistically different between controls and AD patients, and no associations were noted between HMW or LMW tau and MRI structures. In a multivariate analysis controlled for age and education level, the HMW/LMW tau ratio was associated with reduced volume in the left medial and right anterior cingulate gyri, right cerebellum, right thalamus (pulvinar), left frontal cortex, and right parahippocampal region., Conclusions: This exploratory study showed that HMW/LMW tau ratio is significantly higher in AD patients than control subjects, and that it is associated with specific brain regions atrophy. Determination of peripheral markers of AD pathology can help understanding the pathophysiology of neurodegeneration in AD.

Recent genetic and neuropathologic advances support the concept that frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) are overlapping multisystem disorders. While 10-15% of ALS patients fulfil criteria for FTD, features of motor neuron disease appear in approximately 15% of FTD patients, during the evolution of the disease. This overlap has been reinforced by the discovery of Transactive Response DNA Binding Protein 43 kDa (TDP43) inclusions as the main neuropathologic finding in the majority of ALS cases and almost a half of FTD cases. Also, an expansion in the intron of C9ORF72 (chromosome 9p21) has been identified in families affected by ALS, ALS-FTD and FTD. This review provides an update on the recent genetic and neuropathologic findings of ALS and FTD and a characterization of their clinical presentation forms, based on the current diagnostic criteria. Finally it underscores the importance of having a national registry of patients with ALS and FTD, to provide an earlier diagnosis and a multidisciplinary care.

Introduction: Two types of drugs have been approved for the symptomatic treatment of Alzheimer's disease (AD): the cholinesterase inhibitors (ChEIs) and memantine. There is a growing interest to know whether the combination of these drugs is safe and if it adds any clinical benefit to patients., Objective: To systematically review published medical literature assessing the efficacy and tolerability of a combination treatment of memantine and donepezil in AD patients., Methods: We searched PubMed for English and Spanish-language literature, using the terms "Alzheimer's disease," "cholinesterase inhibitors," "donepezil," and "memantine." Our review focused on clinical trials and observational studies., Results: Eleven publications representing seven unique studies were selected for this review. Three were randomized double-blind, placebo-controlled trials and four were observational studies., Conclusions: Available data revealed that the combination of memantine and donepezil slowed down cognitive decline, prolonged functional independence, and improved behavioral symptoms in patients with moderate to severe AD. The long-term use of the dual therapy decreased the risk of nursing home admission. More longitudinal studies are needed to further examine the role of combined therapy in the management of AD patients.

The neuro-scientific study of moral actions and judgments is particularly relevant to medicine, especially when assessing behavior disorders secondary to brain diseases. In this paper, moral behavior is reviewed from an evolutionary and neuro-scientific perspective. We discuss the role of emotions in moral decisions, the role of brain development in moral development and the cerebral basis of moral behavior. Empirical evidence shows a relationship between brain and moral development: changes in cerebral architecture are related to changes in moral decision complexity. Moral development takes a long time, achieving its maturity during adulthood. It is suggested that moral cognition depends on cerebral regions and neural networks related to emotional and cognitive processing (i.e. prefrontal and temporal cortex) and that moral judgments are complex affective and cognitive phenomena. This paper concludes with the suggestion that a satisfactory clinical/legal evaluation of a patient requires that the neural basis of moral behavior should be taken into account.

Background: Restrained eaters (RE) are individuals who restrain their food intake on a regular basis as they are frightened to gain weight. However, they tend to overeat under conditions of anxiety. It has been shown that RE possess a behavioral inhibition system that is more active in tonic terms, which would partially explain their affective vulnerability. Even so, the influence of variations in the activation levels of the emotional systems on the eating behavior of a RE is still unknown. Our hypothesis is that variations of such systems will give place to two types of RE: a successful or a non-successful one., Aim: To assess the influence of variations on the activation of motivational systems in food intake of RE., Materials and Methods: As part of a factorial experimental design, 105 undergraduate university students were part of an experimental test for inducting food intake. Then they reported their levels of dietary restraint and their emotional behavioral preferences., Results: Differences in the activation of motivational systems were significantly related to differences in food intake (F= 7.210; p= 0.001). Additionally, food intake for those RE with a predominant inhibition system tended to be higher than for those with a more active approach system, though the latter did not reach a significant difference (F=0.718; p=0.399)., Conclusions: Although more investigations are required, our data suggest that the success of retaining the diet among the RE would depend on their profile of affective reactivity (affective style). There are putative implications for research on anorexia and obesity.

Behavioral disturbances in dementias are relevant because they are very common, they worsen patients' medical and cognitive condition, increase the caregiver burden and accelerate the admission to nursing homes. The different behavioral disturbances in dementias can appear isolated, but in most cases, patients present a combination of disturbances producing one of two main syndromes: the psychotic or the affective syndrome. Proper handling of these behavioral disturbances requires a correct characterization of the syndrome, discarding medical or environmental causes and selecting the drug with the better effectiveness and safety profile for each patient. In spite of the important number of psychotropics available, there is not enough scientific evidence about their real effectiveness and security in patients with Alzheimer's disease. This article reviews recent advances in the treatment of most common and disruptive behavioral disturbances.

Dementia in general, especially Alzheimer disease and vascular dementia, are diseases of high prevalence with severe socio-economic consequences in all countries. In recent years, due to the obtention of new pharmaceutical products acting on different brain neurotransmitters, there has been important changes in the therapy of these diseases. Although these drugs do not stop disease progression, there is consistent evidence of their usefulness in cognitive, behavioral and functional domains and of their pharmaco-economical justification. This article reviews the main drugs available for Alzheimer disease and some future therapeutic perspectives.